Open Journal of Nursing, 2019, 9, 188-193

http://www.scirp.org/journal/ojn
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ISSN Print: 2162-5336

Understanding the Ethical Theories in Medical

Practice

Ahmed Bait Amer

Sultan Qaboose University Hospital, Muscat, Oman

How to cite this paper: Amer, A.B. (2019) Abstract

Understanding the Ethical Theories in
Medical Practice. Open Journal of Nursing, It is important to understand the basic of the ethical theories and how to util-
9, 188-193. ize them to deal with the ethical dilemma in the medical practice. This article
https://doi.org/10.4236/ojn.2019.92018
presents a brief review of three of famous philosophical theories of ethics,
Received: January 14, 2019 which may enrich our understanding and guide our behaviour in medical
Accepted: February 22, 2019 practice. Conclusion: There is no fully adequate moral theory which can
Published: February 25, 2019 singly explain all ethical or moral dilemmas and none of them also can singly
explain all ethical or moral dilemmas.
Copyright © 2019 by author(s) and
Scientific Research Publishing Inc.
This work is licensed under the Creative Keywords
Commons Attribution International
Ethical Theory, Utilitarianism, Teleology, Deontology, Principlism
License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access

1. Introduction
Clinicians have specific duties of care to their patients and to society. It is gener-
ally held that clinicians should always act in the best interest of their patients;
but sometimes there is a conflict between obligations to a patient and those per-
ceived to be owed to the community or to other patients. It may not always be
the case that what the clinician believes is in the best interest of the patient or is
what the patient wishes or will consent to [1]. The ethical theories provides an
ordered set of moral standards to be used in assessing what is morally right and
what is morally wrong regarding human action in general [2].

2. The Ethical Theory

Is a theory of moral obligation their proponent puts it forth as a framework
within which a person can correctly determine, on any given occasion, what he
or she (morally) ought to do [2]. We will discuss three common ethical theories
and how it handle the case of truth telling in medical practice as an example.

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 A. B. Amer

Teleology and Utilitarianism, deontology, and principlism, these theories can be

applied in several procedures of ethical analysis, such as in analysis of cases (ca-
suistry) and in different settings, moral or ethical theory may consider the ap-
plication of rules or the consequences of actions [3]. Their advantages and dis-
advantage were shown in Table 1.

2.1. Teleology and Utilitarianism

Teleology comes from the Greek for goal (telos) and theory (logos); teleological
theories stress the consequences of actions as the first step in analyzing moral
activity; consequentialism is another name given to this class of theories [4]. It
primarily refers to moral views or theories which base their evaluations of acts
solely on consequences [5]. Consequentialism sees the rightness or the wrong-
ness of an action in terms of the consequences brought by that action [6] or ac-
cording to the balance of their good and bad consequences [7]. The most com-
mon, but not the only, form of consequentialism is utilitarianism or social con-
sequentialism holds that one should act as to do the greatest good for the great-
est number [5]. The major philosophers who developed the utilitarian approach
were Jermy Bentham (1748-1832) and John Stuart Mill (1806-1873). Utilitarian-
ism is the moral/ethical theory that states that right actions ought to produce the
greatest happiness for the greatest number of people [6]. Bentham and Mill are
hedonistic utilitarian’s because they conceive utility entirely in terms of happi-
ness or pleasure, two broad terms that they treat as synonymous [6], J. S. Mill
defined good as the presence of pleasure and the absence of pain [5]. Utilitarian-
ism concentrate on value of well being, which may be analyzed in terms of plea-
sure, happiness, welfare, preference satisfaction or the like, they accept only one
basic principle of ethics: the principle of utility. This principle asserts that we
ought always to produce the maximal balance of positive value over disvalue (or
the least possible disvalue, if only undesirable results can be achieved [6]. This
principle is the main aspect of the consequent list theory which has been put
forward by Bentham and Mill as a universal moral truth, and it is the ultimate
standard of right and wrong for all the utilitarian’s [5], actions are right in pro-
portion as they tend to promote happiness, wrong as they tend to produce the
reverse of happiness so it is the demand to produce the greatest balance of good
over evil [2], from the utilitarian’s perspective the principle of utility is the sole

Table 1. Types of the ethical the ethical theory their advantages and disadvantages.

Types of the theory Advantages Disadvantages

Consequence-based Stresses promotion of Ignores concerns of justice

(Utiltarian) happiness and utility for the minority population

Duty-based Stresses the role of duty Underestimates the importance

(Deontology) and respect for persons of happiness and social utility

Provide a set of moral

Not designed to provide
Principlism commitments, common language
a method for choosing
and a common set of moral issue

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A. B. Amer

and absolute principle of ethics [3]. In contemporary discussions, distinction is

made between two kinds of utilitarianism act utilitarianism and rule-utilitarianism.
The Act utilitarianism: asks what good and bad consequences will probably re-
sult from this action in this circumstances) whereas the rule-utilitarian consider
the consequences of adopting certain rules the act utilitarian’s disregards the
level of rules and justifies actions by direct appeal to the principle of utility [6].
In the spirit of rule utilitarianism, a moral code is first established by reference
to the principles Utility. That is a set of valid moral rules is established by deter-
mining which rules as opposed to conceivable alternatives, if generally followed
would produce the greatest balance of good over evil. In rule-utilitarianism, in-
dividual actions are morally right if they are in accord with those rules [2] in the
truth telling case, the utilitarian effort to do the right thing may place truth tell-
ing secondary to not distressing the patient and therefore an outright lie could
be morally justified [5] (Table 1).

Criticism of Utilitarianism
This theory has been criticized for the fact that one cannot predict the outcome
of actions in advance, thus it is impossible to set the standers of one’s moral ac-
tion on the basis of the act itself [3]. Problems arise for utilitarian’s who are
concerned about the maximization of individual preferences when some of these
individuals have considered what judgments tell us are morally unacceptable
preferences also an additional problem concerned with immoral actions. Sup-
pose the only way to achieve the maximal utilitarian outcome is to perform an
immoral act such as killing one person to distribute his organs to several others
who will die without them. Utilitarianism seems to say not only that such killing
is permissible, but that it is morally obligatory [7].

2.2. Duty Ethics (Deontology)

It denies much that utilitarian theories affirm. Often called deontological or
Nonconsequentialist [7]. The term “deontology” is a modern combination of
classical Greek terms and means the study or science (logos) of duty, or more
precisely of what one ought to do (Deon) [5]. It involves applying the same rule
for every one in all circumstances; the main proponent is Immanuel Kant for
that it was called Kantianism (1724-1804) [8]. In his theory morality provides a
rational framework of universal principles and rules that constrain and guide
everyone. Kant’s supreme, supreme principle of morality, the principle from
which all of our various duties derive, is called by Kant the “Categorical Impera-
tive” and is expressed in several ways in his writings. His first formulation: I
ought never to act except in such a way that I can also will that my maxim be-
come a universal law. Kant says that this principle justifies all particular impera-
tives of obligation (all “ought” statements that morally obligate “This imperative
tells us what must be done irrespective of our desires and the maxim must be
capable of being conceived and willed without contradiction” [7]. The second
formulation is “Act in such way that you always treat humanity whether in your

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 A. B. Amer

own person or in the person of any other, never simply as a means, but always at
the same time as an end”. The first formulation has often been compared with
the golden rule (do unto others as you would have them do unto you) [2]. Un-
like utilitarian’s, deontologists hold that lying is wrong even if a lie would ac-
complish great good for individuals and society [7]. Kant argued for truth and
the strict rejection of all lying. In Kant’s categorical imperative doctrine, truth
telling is a duty (imperative) which binds unconditionally (categorical). A lie is
always evil for Kant because it harms human discourse and the dignity of every
human person. Truth telling is always a duty, whether the other has the right to
know or whether innocent persons will be severely harmed [9] (Table 1).

Criticism to Deontology
Deontology cannot within itself provide for resolution of conflicts among two or
more moral persons who profoundly disagree.

2.3. Principlism
Is a widely applied ethical approach based on four fundamental moral principles
sometimes referred to as “the big four” developed in the 1970s by the Americans
Tom Beauchamp and James Childress [10]? Identify four primary principles as
the followings: 1. Respect for autonomy, 2. Non-Malfeasance, 3. Beneficence (in-
cluding utility) and 4. justice and several derivative rules: veracity, fidelity, pri-
vacy and confidentiality along with various other rules such as informed con-
sent. Danner Clouser and Bernnard Gert (1990) coined the label principlism.
Others have [5] called this frame work the four principles approach (the prin-
ciplism approach argue that the four principles that are included in principlism
express ‘‘the general values underlying rules in the common morality’’), where
the common morality is ‘‘the set of norms that all morally serious persons share’’
[11] and to be applied to solve the contemporary ethical dilemmas [9]. Beau-
champ and childress had said that principlism has proved a popular framework
for thinking about medical ethics, and often forms part of the education for
those coming into medicine. It is not intended to be a general moral theory, but
rather aims to provide a framework to help those working in medicine both to
identify moral problems and to make decisions about what to do. Similarly,
Raanan Gillon has claimed that the four principles can explain and justify all the
substantive and universalisable moral claims in medical ethics [11]. Although
this approach is sometimes criticized for its lack of foundational theory and its
Western-dominated methodology, principlism is widely used as a starting point
for practical ethical decision-making in the clinical, technological and epidemi-
ological professions [10].

Criticism to Principlism
They are not designed to provide a method for choosing, but rather provide a set
of moral commitments, common language and a common set of moral issue
(Table 1).

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A. B. Amer

• Failing to act as action guides [12]. The truth telling case the four principle
are all equally important for guiding the discussion and resolution of the
clinical dilemma of what to tell the patient

2.4. Correlations among the Above Three Ethical Theories

As we notice from the above, each one of the ethical theories had advantages and
also disadvantages and the correlation among them showed that ethics is not a
prescription or set of rules to be followed blindly. There is rarely a single “right”
answer to the ethical dilemmas in practice, but ethics involves a systematic ap-
proach to moral dilemmas. Patients and society should be confident that difficult
choices are not dealt with in an arbitrary fashion, or simply dependent on the
particular moral stand taken by clinicians. Choices should be made or presented
fairly and usually in the best interests of the patient. Ethics is just us much about
HOW dilemmas are resolved than with WHAT the right choices or actions
should be. Central to modern clinical ethics is the dignity and respect for the pa-
tient as individuals capable of understanding and where possible taking deci-
sions about their treatment [13].

3. Conclusion
As we notice from the above mentioned theories every one had it is own advan-
tages, and disadvantages. I agree with Kasule [14] who conclude; there is no fully
adequate moral theory which can singly explain all ethical or moral dilemmas
and none of them also can singly explain all ethical or moral dilemmas. None of
them taken singly has the attributes of a good ethical theory: clear, coherent,
complete, comprehensive, simple, practicable, and able to explain and justify. In
practice more than one theory may have to be combined to solve a specific ethi-
cal issue.

Conflicts of Interest
The author declares no conflicts of interest regarding the publication of this pa-
per.

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